Division of Cardiovascular Medicine and Radiology, University of Michigan, Ann Arbor, Michigan.
Department of Radiology and Division of Cardiology, University of Bordeaux, Bordeaux, France.
J Cardiovasc Electrophysiol. 2020 Jul;31(7):1762-1769. doi: 10.1111/jce.14514. Epub 2020 May 18.
Intramural scarring is a risk factor for sudden cardiac death. The objective of this study was to determine the value of scar quantification for risk stratification in patients with nonischemic cardiomyopathy (NICM) undergoing ablation procedures for ventricular arrhythmias (VA).
Cardiac late gadolinium-enhanced magnetic resonance imaging was performed in patients with NICM referred for ablation of premature ventricular complexes or ventricular tachycardia (VT). Only patients with intramural delayed enhancement were included. Scar volume was measured and correlated with immediate and long-term outcomes. Receiver operator curves, Wilcoxon signed-rank testing, and logistic regression were used to compare patient characteristics. The study consisted of 99 patients (74 males, mean age: 59.6 [54.0-68.1] years, ejection fraction [EF]: 46.0 [35.0-60.0]%). Patients without clinical VT or inducible VT had smaller total and core scar size compared to patients with a history of VT or inducible VT (total scar 1.12 [0.74-1.79] cm vs 7.45 [4.16-12.21] cm , P < .001). A total scar volume of greater than or equal to 2.78 cm was associated with inducibility of VT (AUC 0.94, 95% CI [0.89-0.98], sensitivity 85%, specificity 90%). Scar volume was associated with VT inducibility independent of a prior history of VT or the preprocedure EF (adjusted OR 1.67 [1.24-2.24]/cm , P < .01).
Quantification of scar size in patients with intramural scarring is useful for risk stratification in patients with NICM and VA independent of the EF or a prior history of VT. Scar characteristics of patients without a history of VT who have inducible VT are similar to patients with a history of VT.
室壁内瘢痕是心脏性猝死的一个危险因素。本研究的目的是确定瘢痕定量在非缺血性心肌病（NICM）患者接受室性心律失常（VA）消融治疗时进行风险分层的价值。
对因频发室性早搏或室性心动过速（VT）而接受消融治疗的 NICM 患者进行心脏晚期钆增强磁共振成像检查。仅纳入存在室壁延迟强化的患者。测量瘢痕体积，并与即刻和长期结果相关联。使用受试者工作特征曲线、Wilcoxon 符号秩检验和逻辑回归比较患者特征。该研究共纳入 99 例患者（74 例男性，平均年龄：59.6[54.0-68.1]岁，射血分数[EF]：46.0[35.0-60.0]%）。无临床 VT 或可诱发性 VT 的患者的总瘢痕和核心瘢痕大小明显小于有 VT 或可诱发性 VT 病史的患者（总瘢痕 1.12[0.74-1.79]cm 比 7.45[4.16-12.21]cm ，P<.001）。总瘢痕体积大于或等于 2.78cm 与 VT 可诱发性相关（AUC 0.94[0.89-0.98]，敏感性 85%，特异性 90%）。在调整了 VT 病史或术前 EF 后，瘢痕体积仍与 VT 可诱发性相关（校正后 OR 1.67[1.24-2.24]/cm ，P<.01）。
在 NICM 合并 VA 患者中，定量测量室壁内瘢痕大小有助于进行风险分层，与 EF 或 VT 病史无关。无 VT 病史但可诱发性 VT 的患者的瘢痕特征与有 VT 病史的患者相似。
